It's typical this time of year for the CentraCare Health pediatrician, as parents prep for their children to return to school. Yearly checkups are recommended, and many occur around the start of the school year to coincide with required vaccinations and physicals.

"A lot of pediatrics is preventative care," Amsberry said. "We want to create a medical home for families. We want to make sure kids are staying healthy and up to date."

This time of year, Amsberry often reflects on her former work at a north Ghana hospital.

In the impoverished rural African region she witnessed patients die from tetanus and meningitis while others contracted polio — three diseases for which the Minnesota Department of Health requires vaccinations. The requirements are tied to school grade levels.

"A lot of people think these diseases are eradicated," Amsberry said. "They are still very present and our world keeps getting smaller. These vaccinations are really important to get.

"I've watched families have to go through a death of a very preventable disease — they would kill for those vaccinations."

The Minnesota Department of Health added two new vaccine requirements for this fall — hepatitis A for early childhood care (from birth to age 4) and meningitis for seventh-graders.

Both vaccines have been recommended nationally since 2005. Immunization requirements are established at a state level.

In the 1990s, the Legislature gave the Minnesota Department of Health full authority to establish requirements.

"We've looked over all sorts of data on the disease, vaccine effectiveness, cost of the vaccine and all of the benefits," said Lynn Bahta, an immunization consultant for the Minnesota Department of Health.

"If there is a risk for a child we are going to encourage immunization. We watch the studies and watch the data. We would never recommend something we thought would be dangerous for children."

Opting out

Parents are able to opt their child out of the vaccinations by signing a waiver. Amsberry said it happens occasionally.

"That can be very challenging," Amsberry said. "The first thing we try to do is listen to the parents and understand what their concern is. Sometimes they just need some education, letting them know what diseases we are preventing. We explain the importance of vaccinations and why they are recommended."

Receiving vaccinations often creates anxiety in young patients.

Medical professionals use a number of tricks to try and relieve the anxiety. Sometimes they try bubbles, finger squeezing or toe wiggling.

"We will guide them through the process and use distractions," Amsberry said. "Some kids aren't scared while others are more apprehensive. It's typically short-lived."

Bahta, a former pediatric nurse, recommends that children eat and stay hydrated before receiving vaccines. It helps prevent fainting that occasionally accompanies receiving a vaccine.

"You try not to, but many times they get nervous and tense up all their muscles, and then faint after relaxing and losing all the blood going to their head," Bahta said. "It's not just young girls, either. I've seen it happen to big, burly football players, too. A light snack and some water beforehand really helps."